Robot-assisted partial nephrectomy: How to minimise renal ischaemia

Renal ischaemia research has shown an increase in renal damage proportional to ischaemic time. Therefore, we assessed the importance of renal ischaemic times for warm and cold ischaemia approaches, and explored the different surgical techniques that can help to minimise renal ischaemia in robot-assi...

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Autores principales:	Chandran Tanabalan, Avi Raman, Faiz Mumtaz
Formato:	article
Lenguaje:	EN
Publicado:	Taylor & Francis Group 2018
Materias:	Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/87c7913db72d4284b86f16609596605e
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spelling	oai:doaj.org-article:87c7913db72d4284b86f16609596605e2021-12-02T10:36:47ZRobot-assisted partial nephrectomy: How to minimise renal ischaemia2090-598X10.1016/j.aju.2018.06.002https://doaj.org/article/87c7913db72d4284b86f16609596605e2018-09-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2090598X18300597https://doaj.org/toc/2090-598XRenal ischaemia research has shown an increase in renal damage proportional to ischaemic time. Therefore, we assessed the importance of renal ischaemic times for warm and cold ischaemia approaches, and explored the different surgical techniques that can help to minimise renal ischaemia in robot-assisted partial nephrectomy (RAPN). Minimising renal ischaemia during nephron-sparing surgery (NSS) is a key factor in preserving postoperative renal function. Current data support a safe warm ischaemia time (WIT) of ≤25 min and cold ischaemic time of ≤35 min, resulting in no significant deterioration in renal function. In general, patients undergoing NSS have increased comorbidities, including chronic kidney disease, and in these patients it is difficult to predict their postoperative renal function recovery. With RAPN, efforts should be made to keep the WIT to <25 min, as minimising the ischaemic time is vital for preservation of overall renal function and remains a modifiable risk factor. Parenchymal or segmental artery clamping, early unclamping or off-clamp techniques can be adopted when ischaemic times are likely to be >25 min, but may not lead to superior functional outcome. Careful preoperative planning, tumour factors, and meticulous surgical technique are critical for optimum patient outcome. Keywords: Partial nephrectomy, Ischaemia, Renal cell carcinoma, Renal function, RenorrhaphyChandran TanabalanAvi RamanFaiz MumtazTaylor & Francis GrouparticleDiseases of the genitourinary system. UrologyRC870-923ENArab Journal of Urology, Vol 16, Iss 3, Pp 350-356 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the genitourinary system. Urology RC870-923
spellingShingle	Diseases of the genitourinary system. Urology RC870-923 Chandran Tanabalan Avi Raman Faiz Mumtaz Robot-assisted partial nephrectomy: How to minimise renal ischaemia
description	Renal ischaemia research has shown an increase in renal damage proportional to ischaemic time. Therefore, we assessed the importance of renal ischaemic times for warm and cold ischaemia approaches, and explored the different surgical techniques that can help to minimise renal ischaemia in robot-assisted partial nephrectomy (RAPN). Minimising renal ischaemia during nephron-sparing surgery (NSS) is a key factor in preserving postoperative renal function. Current data support a safe warm ischaemia time (WIT) of ≤25 min and cold ischaemic time of ≤35 min, resulting in no significant deterioration in renal function. In general, patients undergoing NSS have increased comorbidities, including chronic kidney disease, and in these patients it is difficult to predict their postoperative renal function recovery. With RAPN, efforts should be made to keep the WIT to <25 min, as minimising the ischaemic time is vital for preservation of overall renal function and remains a modifiable risk factor. Parenchymal or segmental artery clamping, early unclamping or off-clamp techniques can be adopted when ischaemic times are likely to be >25 min, but may not lead to superior functional outcome. Careful preoperative planning, tumour factors, and meticulous surgical technique are critical for optimum patient outcome. Keywords: Partial nephrectomy, Ischaemia, Renal cell carcinoma, Renal function, Renorrhaphy
format	article
author	Chandran Tanabalan Avi Raman Faiz Mumtaz
author_facet	Chandran Tanabalan Avi Raman Faiz Mumtaz
author_sort	Chandran Tanabalan
title	Robot-assisted partial nephrectomy: How to minimise renal ischaemia
title_short	Robot-assisted partial nephrectomy: How to minimise renal ischaemia
title_full	Robot-assisted partial nephrectomy: How to minimise renal ischaemia
title_fullStr	Robot-assisted partial nephrectomy: How to minimise renal ischaemia
title_full_unstemmed	Robot-assisted partial nephrectomy: How to minimise renal ischaemia
title_sort	robot-assisted partial nephrectomy: how to minimise renal ischaemia
publisher	Taylor & Francis Group
publishDate	2018
url	https://doaj.org/article/87c7913db72d4284b86f16609596605e
work_keys_str_mv	AT chandrantanabalan robotassistedpartialnephrectomyhowtominimiserenalischaemia AT aviraman robotassistedpartialnephrectomyhowtominimiserenalischaemia AT faizmumtaz robotassistedpartialnephrectomyhowtominimiserenalischaemia
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Robot-assisted partial nephrectomy: How to minimise renal ischaemia

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